|Year : 2019 | Volume
| Issue : 1 | Page : 43-44
|Date of Web Publication||14-May-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Video. J Laryngol Voice 2019;9:43-4
| Application of holmium laser in an office-based laryngeal surgery (ABS_028)|| |
Department of Otolaryngology-Head and Neck Surgery, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
Objectives: Office-based laryngeal surgery with laser is successfully used as an alternative treatment for laryngeal lesions. Laser delivery must be through working channel of a flexible nasolaryngoscope. A holmium:YAG (Ho:YAG) laser has been reported in the treatment of tracheobronchial lesion and also benign laryngeal surgery. This video presentation shows an office-based holmiumprompt evaluation and diagnosis, transoral laser treatment of hemorrhagic vocal polyp through a flexible nasolaryngoscope.
Materials and Methods: A 63-year-old with antiplatelet therapy presented to the ENT clinic with hoarseness and vocal fatigue after acute respiratory tract infection. The patient had multiple medical conditions including diabetes, hypertension, and coronary heart disease with recent percutaneous coronary intervention. Preoperative videostroboscopy showed left hemorrhagic vocal polyp and hourglass glottic closure. Regarding his medical condition, an awake office-based laryngeal surgery was offered.
Results: Under topical anesthesia using a flexible nasolaryngoscope, the Ho:YAG laser was delivered via 365-μm quartz fiber through working channel with 0.5 Joule of energy at 10 Hz for power setting of 7.5 Watt. The patient tolerated well during procedure. Postoperative videostroboscopy at 1 month revealed limited vocal stiffness with near-complete glottic closure. The patient was satisfied with his voice.
Conclusion: The Ho:YAG laser can be safe and effective in the treatment of benign laryngeal lesions and should be considered as an alternative laser during an office-based laryngeal surgery.
| Hypernasality in myasthenia gravis (ABS_032)|| |
Leighnette Geronimo, Maria Shamylle Quinto, Celso Ureta
Veterans Memorial Medical Center, Quezon City, Philippines
· To present an unusual case of sudden-onset and persistent hypernasality in an adult female
· To show the approaches done in this patient to come up with the proper diagnosis and management.
Materials and Methods: This case study was done in a tertiary institution involving one patient.
Results: This was a case study, which described an infrequently encountered disorder, myasthenia gravis, having as its primary presenting symptom of hypernasal speech in a 43-year-old female. Complete ENT and cranial examinations with video nasopharyngolaryngoscopy were done, which revealed soft palatal weakness. With an initial assessment of hypernasality secondary to velopharyngeal dysfunction, ORL-HNS specialist still cannot totally rule out a probable neurologic origin, hence referred to a neurologist. Muscle fatigability testing and repetitive nerve stimulation were performed, leading to a final diagnosis of myasthenia gravis. The patient was prescribed with pyridostigmine bromide and prednisone, which markedly alleviated and improved the symptoms within 24 h of intake.
Conclusion: This study presented an unusual presentation of hypernasality in myasthenia gravis, in a 43-year-old female. The multidisciplinary approach of hypernasality along with the aid of the neurologist led to the diagnosis and proper management of myasthenia gravis.
| Transoral excision of the base of the tongue lesion in neonates (ABS_41)|| |
Panchala V. L. N. Murthy1,2
1Department of Pediatric Airway, Rainbow Children's Hospital,2Department of Pediatric Airway, Star Hospitals, Hyderabad, Telangana, India
Objective: To highlight the surgical approach and technique of transoral excision of tongue base lesions in infants.
Methodology: This was a retrospective study of 23 infants aged between 5 days and 1 year, who presented with stridor, feeding issues, and respiratory distress and who underwent microlaryngobronchoscopy (MLB) from June 2018 to July 2019. All the patients underwent surgical intervention for base tongue lesions with coblation.
Results: All the 23 cases presented with severe stridor, respiratory distress, feeding issues, and difficult intubation who underwent MLB, aged between 5 days and 1 year, which necessitated a high-precision instrument with almost bloodless and smokeless surgical field, which can reach the inaccessible area of base tongue. Coblation with EVAC 70 wand helped us target the base of the tongue with high precision thus preserving the surrounding normal tissue. All the 23 cases had an uneventful postoperative period and smooth recovery, had an early introduction of mother feeding, and discharge from the hospital.
Conclusion: Airway disorders are common in the pediatric population who will present with stridor, respiratory distress, and life-threatening episodes. Early recognition and intervention hold the key for an early recovery and minimizing the failure to thrive secondary to poor feeding in cases of neonatal base tongue lesions.
| Tracheal hamartoma: A rare cause of lumen occlusion (ABS_046)|| |
Department of ENT and Head Neck Surgery, Seth G.S. Medical College, Parel, Mumbai, Maharashtra, India
Hamartoma is rarely found to be localized in the trachea. A 34-year-old male who was being treated for asthma for 6 months presented to our hospital with a progressive inspiratory stridor associated with headache and tachycardia.
Computed tomography neck revealed a mass 6 cm above the carina obstructing the lumen of the trachea. The mass was attached to the posterior wall of the trachea. The patient was maintained with AIRVO nasal cannulation under strict arterial blood gases and vital monitoring.
Endoscopic resection was done with an electrocautery via an access through a low tracheostoma. Histopathological examination of the lesion indicated that it was a hamartoma.
| Feminization glottoplasty (ABS_056)|| |
Sachin Gandhi, Asheesh Dora Ghanpur
Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
Objective: To report one case of feminization glottoplasty done at our center.
Materials and Methodology: A 37-year-old transgender has presented with a desire to undergo voice transformation surgery. The patient has tried voice therapy, but was not really happy with the results as the patient had to strain a lot and make conscious effort to sound like a female. The patient was treated with Wendler's technique with minor modification of using KTP-laser to create raw surface over the anterior commissure and anterior third of both vocal folds, suturing of the two vocal folds with two stitches of 5-0 vicryl, and careful application of fibrin glue. Pre- and postprocedure voice analysis was done.
Results: The patient was followed up after 3 months postprocedure and was happy with the voice quality. Stroboscopy showed normal vibratory pattern of two vocal folds and a decrease in effective vibratory area. The voice analysis showed an increase in the fundamental frequency.
Conclusion: Wendler's glottoplasty is effective to feminize the voice.
| Endoscopic type II laryngeal cleft repair in an 18-month-old male child (ABS_058)|| |
Sachin Gandhi, Shradha Saindani
Department of Otorhinolaryngology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
Objective: To report one case of type II laryngeal cleft, operated at our center by transoral endoscopic method.
Materials and Methodology: An 18-month-old male child with feeding difficulty, recurrent aspiration pneumonia, and poor weight gain, who underwent tracheostomy at a peripheral center, was referred for further evaluation and management. The child was subjected to clinical flexible laryngoscopy and was found to have redundant arytenoids obstructing airway and aspiration of saliva. On microlaryngoscopy, the child was diagnosed with type II laryngeal cleft. Endoscopic cleft repair was done by excising the redundant mucosa and refreshening the edges by KTP laser and then the edges sutured by vicryl 5-0.
Results: The child was followed up after 3 weeks, 6 weeks, 3 months, and 6 months. Postprocedure aspiration was controlled and the child started gaining weight.
Conclusion: Any neonate presenting with choking spells after taking feeds should raise a suspicion of laryngeal cleft. With prompt evaluation and diagnosis, transoral endoscopic repair and suturing can be done.
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